IN THE CIRCUIT COURT OF _____________________________ COUNTY, MISSOURI Case Number: Probate Division In the Estate of ___________________________________, Deceased. (Date File Stamp) Application of Surviving Spouse for Refusal of Letters The applicant, surviving spouse of the decedent, states that decedent date of birth was ________________________ and decedent died on _________________________ residing at ___________________________________________________________________________ ________________________________________________________________, survived by applicant and ______________________________ unmarried minor child(ren), leaving an estate in this state, the value of which, less liens and encumbrances, is not greater in amount than is allowed by the law as exempt property and maintenance of applicant and unmarried minor child(ren) for one year after the death of decedent. The estate consists solely of the property described and of value as follows: Description of Property Value _____________________ Total $ See Appendix A. Unmarried minor child(ren) of the decedent who is(are) not the child(ren) of the applicant is(are) as follows: Name of Child Date of Birth Name/Address of Custodian Wherefore, applicant prays the court order that no letters be granted on said estate unless on the application of creditors or other interested parties, the existence of other or further property is shown. The applicant swears that the matters set forth above are true and correct to the best knowledge and belief of the applicant, subject to the penalties of making a false affidavit or declaration. Date: _______________________________ ______________________________________ Signature of Attorney for Applicant _________________________________ Signature of Applicant _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ (Name/Bar Number/Address/Telephone) _________________________________ (Name/Address/Telephone) OSCA (8-02) PR33 549 1 of 2 473.090.1 (1) RSMo American LegalNet, Inc. www.FormsWorkflow.com Appendix A Decedent: Case Number: Description of Property Value Real Property Personal Property TOTAL: ___________ OSCA (8-02) PR33 549 2 of 2 473.090.1 (1) RSMo American LegalNet, Inc. www.FormsWorkflow.com